Sandbox ID Lower Respiratory Tract: Difference between revisions
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===Pneumonia, Acinetobacter=== | ===Pneumonia, Acinetobacter=== | ||
:* (H) Acinetobacter species (atypical bacterial pneumonia) | |||
:::* Preferred Regimen : [[Carbapenem]] ([[Imipenem]]-[[cilastatin]], {{or}} [[meropenem]], {{or}} [[ertapenem]]) | |||
:::* Alternate Regimen: [[Cephalosporin]]-[[aminoglycoside]] {{or}} [[Ampicillin-sulbactam]] {{or}} [[Colistin]] 2.5-5 mg/kg/day IM/IV divided q6-12h (maximum: 5 mg/kg/day) | |||
===Pneumonia, Actinomycosis=== | ===Pneumonia, Actinomycosis=== |
Revision as of 18:11, 10 June 2015
Acute bacterial exacerbations of chronic bronchitis
Bronchiectasis
Bronchiolitis
Bronchitis
Cystic fibrosis
Empyema
Influenza
Inhalational anthrax, Prophylaxis
Inhalational anthrax, Treatment
Pertussis
Pneumonia, Acinetobacter
- (H) Acinetobacter species (atypical bacterial pneumonia)
- Preferred Regimen : Carbapenem (Imipenem-cilastatin, OR meropenem, OR ertapenem)
- Alternate Regimen: Cephalosporin-aminoglycoside OR Ampicillin-sulbactam OR Colistin 2.5-5 mg/kg/day IM/IV divided q6-12h (maximum: 5 mg/kg/day)
Pneumonia, Actinomycosis
Pneumonia, Anaerobes
Pneumonia, Aspiration pneumonia
Pneumonia, Chlamydophila
- Chlamydophila pneumoniae (atypical bacterial pneumonia)
- Preferred Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h OR Tetracycline 250-500 mg PO q6h
- Alternate Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h
Pneumonia, community-acquired
- Community acquired pneumonia
- Empiric therapy in adults
- (A) Outpatient treatment
- (1) Previously healthy and no use of antimicrobials within the previous 3 months.
- Preferred regimen : Azithromycin 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 OR Azithromycin 500 mg IV as a single dose OR Clarithromycin 250 mg q12h for 7-14 days OR 1000 mg q24h for 7 days OR Erythromycin 250-500 mg q6-12h (max: 4 g/day)
- Alternative regimen : Doxycycline 100 mg PO/IV q12h (Weak recommendation).
- (2) Presence of comorbidities such as chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; or use of antimicrobials within the previous 3 months (in this case an alternative from a different class should be selected)
- Preferred regimen (1) : Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days
- Preferred Regimen (2) : (Amoxicillin 875 mg PO q12h or 500 mg q8h OR Amoxicillin-clavulanate 2 g q12h OR Ceftriaxone 1 g IV q24h, (2 g q24h for patients at risk) OR Cefpodoxime 200 mg PO q12h for 14 days OR Cefuroxime 750 mg IM/IV q8h) AND ( Macrolide Azithromycin 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 OR Doxycycline 100 mg PO/IV q12h)
- (B) Inpatient Therapy (in regions with a high rate (125%) of infection with high-level (minimum inhibitory concentration 16 mg/mL) macrolide-resistant Streptococcus pneumoniae)
- (1) Non-ICU treatment
- Preferred Regimen : Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days OR Amoxicillin 1 g q8h OR Amoxicillin-clavulanate 2 g q12h
- Alternative Regimen : Ceftriaxone 1 g IV q24h, (2 g q24h for patients at risk) OR Cefpodoxime 200 mg PO q12h for 14 days OR Cefuroxime 750 mg IM/IV q8h
- (2) ICU treatment
- Preferred Regimen : (Cefotaxime I.M., I.V.: 1 g q12h OR Ceftriaxone 1 g IV q24h, 2 g/day for patients at risk OR Ampicillin-sulbactam 1.5-3 g IV q6h) AND (Azithromycin 500 mg/day PO once, followed by 250 mg q24h for 4 days OR Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin Oral: 320 mg q24h for 5 or 7 days)
- Alternative Regimen (For penicillin allergy): (Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 day OR Moxifloxacin 400 mg q24h PO/IV for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days) AND Aztreonam I.V.: 2 g q6-8h (max: 8 g/day)
- (C) Special Concerns
- (1) Pseudomonas
- Preferred Regimen (1): (Piperacillin-tazobactam 3.375 g IV q6h for 7-10 days OR Cefepime 1-2 g q12h for 10 days OR Imipenem 500 mg IV q6h OR Meropenem 500 mg IV q8h) AND (Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 day)
- Preferred Regimen (2): (Piperacillin-tazobactam 3.375 g IV q6h for 7-10 days OR Cefepime 1-2 g q12h for 10 days OR Imipenem 500 mg IV q6h OR Meropenem 500 mg IV q8h) AND Aminoglycoside AND (Azithromycin Oral: 500 mg on day 1 followed by 250 mg q24h on days 2-5 OR Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days)
- Note : For penicillin-allergic patients, substitute the B-lactam for Aztreonam 2 g IV q6-8h (maximum 8 g/day)
- (2) Methicillin resistant staphylococcus aureus ,Add the following to the selected regimen
- Preferred regimen: Vancomycin 45-60 mg/kg/day divided q8-12h OR Linezolid 600 mg PO/IV q12h for 10-14 days.
- Empiric therapy in neonates ( Age < 1 month)
- Preferred regimen: Ampicillin 500 mg/day for 7-14 days or 750 mg/day for 5 days OR Gentamicin 400 mg/day PO/IV for 7-14 days With or without Cefotaxime 320 mg PO q24h for 5 or 7 days
- Note (1) : If methicillin resistant staphylococcus aureus is suspected, add the following Vancomycin 10 mg/kg q8h
- Note (2) : If Chlamydia trachomatis is suspected, add the following Erythromycin 12.5 mg/kg PO or IV qid for 14 days OR Azithromycin 10 mg/kg PO/IV on day one then 5 mg/kg PO/IV q24h for 4 days.
- Alternate Regimen (If methicillin resistant staphylococcus aureus is suspected): Vancomycin 10 mg/kg q8h OR Linezolid 10 mg/kg q8h
- Empiric therapy,Children (> 3 months) Outpatient Therapy
- Preferred Regimen: Amoxicillin 90 mg/kg/day q12h for 5 days OR Azithromycin 10 mg/kg PO 1 dose (max 500 mg), then 5 mg/kg (max 250 mg) PO for 4 days
- Alternate Regimen: Amoxicillin-clavulanate 90 mg/kg/day OR Clarithromycin 15 mg/kg/day q12h for 7-14 days
- pathogen directed antimicrobial therapy
- Bacterial
- (A) Streptococcus pneumoniae
- (1) Penicillin nonresistant; minimum inhibitory concentration < 2 mg / mL
- Preferred Regimen : Penicillin G 2-3 million units IV q4h OR Amoxicillin 875 mg PO q12h or 500 mg q8h
- Alternative Regimen : Azithromycin 500 mg PO on day 1 followed by 250 mg q24h OR Cefpodoxime 200 mg PO q12h for 14 days OR Cefprozil 500 mg PO q12h for 10 days OR Cefuroxime 750 mg PO/IV q8h OR Cefdinir 300 mg PO q12h for 10 days OR Cefditoren 400 mg PO q12h for 14 day OR Ceftriaxone 1 g IV q24h, 2 g daily for patients at risk OR Cefotaxime 1 g IM/IV q12h OR Clindamycin 150-450 mg PO q6-8h (maximum: 1800 mg/day) OR Clindamycin 1.2-2.7 g/day IM/IV in 2-4 divided doses (maximum:4800 mg/day) OR Doxycycline 100 mg PI/IV q12h OR Respiratory levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h.
- (2) Penicillin resistant; minimum inhibitory concentration > 2 mg / mL
- Preferred Regimen (Agents chosen on the basis of susceptibililty) : Cefotaxime 1 g IM/IV q12h OR Ceftriaxone 1 g IV q24h, 2 g daily for patients at risk OR levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h
- Alternative Regimen: Vancomycin 45-60 mg/kg/day divided q8-12h (maximum: 2000 mg/dose) for 7-21 days depending on severity OR Linezolid 600 mg PO/IV q12h for 10-14 days OR Amoxicillin 875 mg PO q12h or 500 mg q8 ( 3 g/day with penicillin ,minimum inhibitory concentration 4 ≤ microgram / mL)
- (B)Haemophilus influenzae
- (1) Non–B-lactamase producing
- Preferred Regimen: Amoxicillin 875 mg PO q12h or 500 mg q8h
- Alternative Regimen : levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h OR Doxycycline 100 mg PO/IV q12h OR Azithromycin 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 OR Clarithromycin 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days
- (2) B-lactamase producing
- Preferred Regimen: 2nd or 3rd Generation Cephalosporin OR Amoxicillin-clavulanate 2 g q12h
- Alternative Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h OR Doxycycline 100 mg PO/IV q12h OR Azithromycin 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 OR Clarithromycin 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days
- (C) Bacillus anthracis (inhalation)
- Preferred Regimen :Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Doxycycline 100 mg PO/IV q12h
- Alternate Regimen : Other fluoroquinolones OR B-lactam (if susceptible) OR Rifampin 600 mg PO/IV q24h for 4 days OR Clindamycin 150-450 mg PO q6-8h OR Chloramphenicol 50-100 mg/kg/day IV in divided q6h
- (D) Enterobacteriaceae
- Preferred Regimen: 3rd generation cephalosporin OR Carbapenem- (Imipenem-cilastatin, OR meropenem, OR ertapenem) (drug of choice if extended-spectrum b-lactamase producer)
- Alternate Regimen : b-Lactam / b-lactamase inhibitor- (Piperacillin-tazobactam for gram-negative bacilli, OR ticarcillin-clavulanate OR ampicillin-sulbactam OR amoxicillin-clavulanate) OR (levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h)
- (E)Pseudomonas aeruginosa
- Preferred Regimen: (Ticarcillin 200-300 mg/kg/day in divided doses q4-6h (max: 18 g/day) OR Piperacillin 6-8 g/day IM/IV (100-125 mg/kg daily) divided q6-12h OR Ceftazidime 500 mg to 1 g q8h OR Cefepime 1-2 g q12h for 10 days OR Aztreonam 2 g IV q6-8h (max: 8 g/day) ORImipenem 500 mg IV q6h OR Meropenem 500 mg IV q8h) AND (Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 750 mg daily OR Aminoglycoside)
- Alternate Regimen: Aminoglycoside AND (Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 750 mg daily)
- (F)Staphylococcus aureus
- (1) Methicillin susceptible
- Preferred Regimen : Nafcillin 1000-2000 mg q4h OR Oxacillin 2 g IV q4h OR Flucloxacillin 250 mg IM/IV q6h
- Alternative Regimen : Cefazolin 500 mg IV q12h OR Clindamycin 150-450 mg PO q6-8h
- (2) Methicillin resistant
- Preferred Regimen : Vancomycin 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days OR Linezolid 600 mg PO/IV q12h for 10-14 days
- Alternative Regimen: Trimethoprim-sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h
- (G)Bordetella pertussis
- Preferred Regimen:Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
- Alternate Regimen: Trimethoprim-sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h
- (H) Anaerobe (aspiration)
- Preferred Regimen: Piperacillin-tazobactam 3.375 g IV q6h for 7-10 days (For gram-negative bacilli) OR Ticarcillin clavulanate 200-300 mg/kg/day IV divided q4-6h (max: 18 g/day) OR Ampicillin-sulbactam 1500-3000 mg IV q6h OR Amoxicillin-clavulanate 250-500 mg PO q8h or 875 mg q12h OR Clindamycin 150-450 mg PO q6-8h (max: 1800 mg/day)
- Alternate Regimen: Carbapenem
- (I) Mycobacterium tuberculosis
- Preferred Regimen:
- Intensive phase: Isoniazid 5 mg/kg/day q24h daily for 2 months (usual dose: 300 mg/day) AND Rifampin 10 mg/kg/day daily for 2 months (maximum: 600 mg / day) AND Ethambutol 5-25 mg/kg daily for 2 months (maximum dose: 1.6 g) AND Pyrazinamide 1000 - 2000 mg / day daily for 2 months.
- Continuation phase: Isoniazid 300 mg/day PO daily for 4 months (5 mg/kg/day) AND Rifampicin 600 mg/day PO daily for 4 months (10 mg/kg/day).
- Alternate regimen (1):
- Intensive phase: Isoniazid 5 mg/kg/day q24h daily for 2 months (usual dose: 300 mg/day) AND Rifampin 10 mg/kg/day daily for 2 months (maximum: 600 mg / day) AND Ethambutol 5-25 mg/kg daily for 2 months (maximum dose: 1.6 g) AND Pyrazinamide 1000 - 2000 mg / day daily for 2 months.
- Continuation phase: Isoniazid 300 mg/day PO 3 times per week for 4 months (5 mg/kg/day) AND Rifampicin 600 mg/day PO 3 times per week for 4 months (10 mg/kg/day).
- Note : Acceptable alternative for any new TB patient receiving directly observed therapy
- Alternate regimen (2)
- Intensive phase:Isoniazid 5 mg/kg/day q24h 3 times per week for 2 months (usual dose: 300 mg/day) AND Rifampin 10 mg/kg/day 3 times per week for 2 months (maximum: 600 mg / day) s AND Ethambutol 5-25 mg/kg (maximum dose: 1.6 g) 3 times per week for 2 months AND Pyrazinamide 1000 - 2000 mg / day 3 times per week for 2 months.
- Continuation phase: Isoniazid 300 mg/day PO 3 times per week for 4 months (5 mg/kg/day) AND Rifampicin 600 mg/day PO 3 times per week for 4 months (10 mg/kg/day).
- Note : Acceptable alternative provided that the patient is receiving directly observed therapy and is not living with HIV or living in an HIV prevalent setting.
- (J) Yersinisa pestis
- Preferred Regimen: Streptomycin 15 mg/kg/day (max 1 g/day) OR Gentamicin 7 mg/kg/day
- Alternate Regimen: Doxycycline 100 mg PO/IV q12h OR levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h
- Atypical bacteria
- (A) Mycoplasma pneumoniae
- Preferred Regimen:Azithromycin 500 mg PO on day 1 followed by 250 mg q24h OR Tetracycline Oral: 250-500 mg q6h
- Alternate Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h
- (B) Chlamydophila pneumoniae
- Preferred Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h OR Tetracycline 250-500 mg PO q6h
- Alternate Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h
- (C) Legionella species
- Preferred Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h OR Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
- Alternate Regimen: Doxycycline 100 mg PO/IV q12h
- (D)Chlamydophila psittaci
- Preferred Regimen: Tetracycline 250-500 mg PO q6h
- Alternate Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
- (E) Coxiella burnetii
- Preferred Regimen: Tetracycline 250-500 mg PO q6h
- Alternate Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
- (F) Francisella tularensis
- Preferred Regimen: Doxycycline
- Alternate Regimen: Gentamicin 7 mg/kg/day OR Streptomycin 15 mg/kg/day (maximum: 1 g)
- (G) Burkholderia pseudomallei
- Preferred Regimen : Carbapenem OR Ceftazidime 0.5-1 g q8h
- Alternate Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h OR Trimethoprim-sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h
- (H) Acinetobacter species
- Preferred Regimen : Carbapenem
- Alternate Regimen: Cephalosporin-aminoglycoside OR Ampicillin-sulbactam OR Colistin 2.5-5 mg/kg/day IM/IV divided q6-12h (max: 5 mg/kg/day)
- Viral
- Influenza virus
- Preferred Regimen: Oseltamivir 75 mg PO q12h for 5 days (initiated within 48 hours of onset of symptoms) OR Zanamivir Two inhalations (10 mg total) q12h for 5 days (Doses on first day should be separated by at least 2 hours; on subsequent days, doses should be spaced by ~12 hours)
- Fungal
- (A) Coccidioides species
- Preferred Regimen: Itraconazole 200 mg q12h OR Fluconazole 200-400 mg daily for 3-6 month
- Alternate Regimen: Amphotericin B 0.5-0.7 mg/kg/day
- Note: No therapy is indicated for uncomplicated infection, treat only if complicated infection
- (B) Histoplasmosis
- Preferred Regimen: Itraconazole 200 mg q12h
- Alternate Regimen: Amphotericin B 0.5-0.7 mg/kg/day
- (C) Blastomycosis
- Preferred Regimen: Itraconazole 200 mg q12h
- Alternate Regimen: Amphotericin B 0.5-0.7 mg/kg/day
Pneumonia, concomitant influenza
Pneumonia, Cytomegalovirus
Pneumonia, Haemophilus Influenza
Pneumonia, health care-associated
Pneumonia, hospital-acquired
Pneumonia, Klebsiella
Pneumonia, Legionella
- Legionella pneumonia (atypical pneumonia)
- Preferred Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h OR Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
- Alternate Regimen: Doxycycline 100 mg PO/IV q12h
Pneumonia, Lung abscess
Pneumonia, Meliodosis
Pneumonia, Moraxella catarrhalis
Pneumonia, Mycoplasma
- Mycoplasma pneumoniae (atypical pneumonia)
- Preferred Regimen:Azithromycin 500 mg PO on day 1 followed by 250 mg q24h OR Tetracycline Oral: 250-500 mg q6h
- Alternate Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h
Pneumonia, neutropenic patient
Pneumonia, Nocardia
Pneumonia, post-influenza
Pneumonia, Pseuodomonas
- Pseudomonas aeruginosa pneumonia
- Preferred Regimen: (Ticarcillin 200-300 mg/kg/day in divided doses q4-6h (maximum: 18 g/day) OR Piperacillin 6-8 g/day IM/IV (100-125 mg/kg daily) divided q6-12h OR Ceftazidime 500 mg to 1 g q8h OR Cefepime 1-2 g q12h for 10 days OR Aztreonam 2 g IV q6-8h (maximum: 8 g/day) OR Imipenem 500 mg IV q6h OR Meropenem 500 mg IV q8h) AND (Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 750 mg daily OR Aminoglycoside)
- Alternate Regimen: Aminoglycoside AND (Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 750 mg daily)
Pneumonia, Staphylococcus aureus
- Staphylococcus aureus pneumonia
- (1) Methicillin susceptible
- Preferred Regimen : Nafcillin 1000-2000 mg q4h OR Oxacillin 2 g IV q4h OR Flucloxacillin 250 mg IM/IV q6h
- Alternative Regimen : Cefazolin 500 mg IV q12h OR Clindamycin 150-450 mg PO q6-8h
- (2) Methicillin resistant
- Preferred Regimen : Vancomycin 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days OR Linezolid 600 mg PO/IV q12h for 10-14 days
- Alternative Regimen: Trimethoprim-sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h
Pneumonia, Stenotrophomonas
Pneumonia, Streptococcus pneumoniae
- Streptococcus pneumoniae
- (1) Penicillin nonresistant; minimum inhibitory concentration < 2 mg / mL
- Preferred Regimen : Penicillin G 2-3 million units IV q4h OR Amoxicillin 875 mg PO q12h or 500 mg q8h
- Alternative Regimen : Azithromycin 500 mg PO on day 1 followed by 250 mg q24h OR Cefpodoxime 200 mg PO q12h for 14 days OR Cefprozil 500 mg PO q12h for 10 days OR Cefuroxime 750 mg PO/IV q8h OR Cefdinir 300 mg PO q12h for 10 days OR Cefditoren 400 mg PO q12h for 14 day OR Ceftriaxone 1 g IV q24h, 2 g daily for patients at risk OR Cefotaxime 1 g IM/IV q12h OR Clindamycin 150-450 mg PO q6-8h (maximum: 1800 mg/day) OR Clindamycin 1.2-2.7 g/day IM/IV in 2-4 divided doses (maximum:4800 mg/day) OR Doxycycline 100 mg PI/IV q12h OR levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h.
- (2) Penicillin resistant; minimum inhibitory concentration > 2 mg / mL
- Preferred Regimen (Agents chosen on the basis of susceptibililty) : Cefotaxime 1 g IM/IV q12h OR Ceftriaxone 1 g IV q24h, 2 g daily for patients at risk OR levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h
- Alternative Regimen: Vancomycin 45-60 mg/kg/day divided q8-12h (maximum: 2000 mg/dose) for 7-21 days depending on severity OR Linezolid 600 mg PO/IV q12h for 10-14 days OR Amoxicillin 875 mg PO q12h or 500 mg q8 ( 3 g/day with penicillin ,minimum inhibitory concentration 4 ≤ microgram / mL)
Pneumonia, Tularemia
- Francisella tularensis pneumonia
- Preferred Regimen: Doxycycline 100 mg PO/IV q12h
- Alternate Regimen: Gentamicin 7 mg/kg/day OR Streptomycin 15 mg/kg/day (maximum: 1 g)
Pneumonia, Yersinia pestis
- Yersinisa pestis pneumonia
- Preferred Regimen: Streptomycin 15 mg/kg/day (max 1 g/day) OR Gentamicin 7 mg/kg/day
- Alternate Regimen: Doxycycline 100 mg PO/IV q12h OR levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h